Provider Demographics
NPI:1104202993
Name:VICTORIA VAMOS, NURSE PRACTITIONER IN FAMILY HEALTH, P.C.
Entity Type:Organization
Organization Name:VICTORIA VAMOS, NURSE PRACTITIONER IN FAMILY HEALTH, P.C.
Other - Org Name:LONG ISLAND MEDICAL AND SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:631-580-0000
Mailing Address - Street 1:751 COATES AVE
Mailing Address - Street 2:SUITE 31
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-6039
Mailing Address - Country:US
Mailing Address - Phone:631-580-0000
Mailing Address - Fax:631-580-0001
Practice Address - Street 1:751 COATES AVE
Practice Address - Street 2:SUITE 31
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-6039
Practice Address - Country:US
Practice Address - Phone:631-580-0000
Practice Address - Fax:631-580-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333441364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02633829Medicaid
NYQ26270Medicare UPIN